Anne Longfield, the Children’s Commissioner for England, has published her third annual children’s mental health briefing, ‘The state of children’s mental health services’. Although welcoming some improvements to children’s mental health services, Longfield warns that a service that meets the needs of all children who need treatment is still a decade away.

"We are still a decade away from a decent mental health service for all children".

Key findings

  • Children receive only a fraction of the help available to adults for mental health support – £225 for every adult compared to £92 for every child.
  • Despite making up 20% of the population, research shows children only receive 10% of total mental health spending.
  • Some areas are spending ten times more than others on children’s mental health.

The report shines a light on the provision of Child and Adolescent Mental Health Services (CAMHS) for the hundreds of thousands of children who need help, support, and treatment. The briefing also looks ahead to assess whether current Government plans go far enough to meet demand.

To maintain the current rate of expansion of services will require significant commitment and resources beyond 2024/25. The Children’s Commissioner finds that more can be done in the next five years.

Longfield has sent formal statutory notices to a number of areas which national data indicates are lagging behind other areas of the country.


This year’s briefing shows that while the NHS has made tangible progress in the provision of mental health services for children, the current system is still far away from adequately meeting the needs of all of the estimated 12.8% of children in England with mental health problems – or the many more children who fall just below the threshold for clinical diagnosis.

The Children’s Commissioner welcomes the significant progress made to CAMHS, but warns that a chasm remains between the current levels of NHS services and what children need.

Overall, the report shows services are improving, with an extra £60m invested in specialist children’s mental health services and an additional 53,000 children entering treatment.

There has been a particular improvement in eating disorder services, where the number of children accessing services has increased by almost 50% since 2016/17. However, services are still far from where they need to be.

Waiting times

  • On average children are waiting just under 8 weeks (53 days, down from 57 days a year ago) to enter treatment (if a referral is made and accepted). 
  • Where a waiting time target has been introduced – currently just for eating disorders – waiting times are much shorter and 80% of children whose referrals were accepted accessed eating disorder services within 4 weeks.*


  • Out of 195 CCGs in England, 161 increased spending on CAMHS (per child) in 2018/19.
  • On average, spending went up from £54 per child to £59 per child in real terms. As a result, an additional £50m (in real terms) was spent on children’s mental health across England and an extra 53,000 children received treatment.
  • Islington is the top spending CCG at £191 per child; it is also the only CCG in England to commit
    more than 2% of its overall budget on children’s mental health.
  • The lowest spending CCG is Derbyshire's Hardwick which spends just £19 per child. 
  • Regional spending per child (2018/19):
    • £62 - London
    • £62 - North of England
    • £60 - South West
    • £58 - Midlands and East of England
    • £53 - South East

Clinical thresholds and referral rejection 

  • Treatment varies hugely across the country. There are four CCGs where more than 90% of children referred entered treatment: Southwark, Croydon, Corby and Lambeth.
  • In Southwark, 93% of children referred accessed CAMHS, and they have a target for this to be 100% by 2020.
  • There are also 10 CCGs where more than half of children referred to CAMHS don’t go on to enter treatment, including Knowsley where 64% of children referred to CAMHS have their referral closed before treatment.

Anne Longfield, the Children’s Commissioner for England, commenting on the report, said:

“There has been welcome progress on children’s mental health services over the last couple of years, and more progress is promised over the next few years. Nevertheless, there is still a chasm between what children need and what is being provided. More children are seeking help for their mental health and the Government need to make sure that help is available. We are still a decade away from a decent mental health service for all children.

“It is still not clear whether national and local government and the NHS is facing up to the scale of problems in children’s mental health services and the devastating impact this has on children. The Government doesn’t have a plan for a comprehensive service in every area and there is still no commitment to a counsellor in every school, which would make a huge difference.

“After years of Government announcements on children’s mental health, children’s mental health remains the poor relation of NHS spending, receiving a fraction of the money invested in adults. Most areas are still spending less than 1% of their budget on children’s mental health services, and the postcode lottery of care means some areas are years ahead of others in improving services.

“It is important to recognize and welcome the real progress that is being made. More children are receiving the help they need and even more will in the future. But the Government urgently needs to commit in the next Spending Review to providing help for 100% of children, not just 20%. If not, thousands of children with mental health problems will continue to suffer and become adults without getting the help they need". 


*Data for referral acceptance rates in eating disorder services are unavailable. 

Read the full report here and the accompanying technical report here